Scrub typhus is a life-threatening disease caused by Orientia tsutsugamushi, a LPS-negative bacterium that replicates preferentially in endothelial cells (EC) and phagocytes. While one million people are infected yearly, with about one-third of world population at risk of infection, effective strategies for infection control are lacking. Information on disease pathogenesis and immune dysregulation is limited. To address these challenges, we have developed mouse models that mimic certain key pathological features of human scrub typhus. We found that endogenous damage-associated molecular pattern (DAMP) molecules such as HMGB1 and myeloperoxidase (MPO) are key regulators responsible for molecular dysfunctions involving angiopoietin 2 (Ang2), Tie2, and CD41+ platelets. We also discovered the detrimental effect of sustained neutrophil activation in thrombocytopenia and vascular injury, and the potential of Ang2 and miR-200b as unique biomarkers for vascular dysfunction. The objective of this study is to define pathogenic mechanisms of vascular dysfunction and therapeutic modalities for severe scrub typhus by utilizing the EC-targeting model of O. tsutsugamushi infection. Our central hypothesis is that the infection-triggered release of DAMPs exacerbates O. tsutsugamushi-induced vascular damage by altering neutrophil/platelet activation; interventions aimed at preserving vascular integrity or phagocyte function help to elicit a balanced immunity against acute tissue damage and severe scrub typhus. This hypothesis will be tested in three cohesive Specific Aims. Aim 1 will examine the mechanisms of HMGB1- and TNF?-mediated sensitization and exacerbation of human endothelium in Orientia infection. We will use human microvascular endothelial cells (HMEC) to test whether Orientia triggers the release of HMGB1, TNF?, Ang2, and miR-200b and their target genes/proteins, and if therapeutics targeting these mechanisms mitigate EC injury. Aim 2 will examine mechanisms by which neutrophils and HMGB1 contribute to vascular and platelet dysfunction during infection in mice. We will set up lethal and sublethal infections in CXCR2-/- or MPO-/- mice at different infection stages. Likewise, the deletion of RAGE (a HMGB1 receptor, RAGE-/- mice) or anti-RAGE antibody will reveal specific roles of HMGB1/RAGE signaling in tissue-infiltrated leukocytes, platelet and vascular function. Aim 3 will test whether anti-Ang2 and statin-based therapeutics promote host survival via modulating vascular function and phagocyte activation in mice. Mice will be treated with anti-Ang2 antibody, recombinant Ang1, or statins (alone or in combination) before or during lethal and sublethal infection. We will examine bacterial dissemination, neutrophil/platelet activation, and the levels of Tie2 and signature cytokines/DAMPs. This mechanism-focused study capitalizes on the synergism among several research teams. Discovery of vascular-specific biomarkers, novel regulatory pathways, and their impact on immune responses to Orientia is timely, innovative and highly significant.